Category Archives: pregnancy

This Postpartum Body

18 Wednesday Apr 2018

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I often joke about my uterus deserving a participation trophy: it tried, bless it, but it really wasn’t totally up to the task. My first child, though term, was so small that he was barely on the growth chart (he was, and is, developmentally fine – he was just small for gestational age). My second pregnancy lasted eleven weeks and one day. My third time, I made it to 31 weeksbefore delivering two babies, by dramatic emergency c section, whose combined weight was less than my first child.

I have stretch marks, but because all my children were so small, I don’t have the dramatic diastasis recti or saggy skin on my stomach that is the aftermath of a healthier twin pregnancy. I’ve mostly lost the weight I gained and am at the same weight now as when I first got pregnant. I don’t really have much to complain about, really.

Of course that’s not stopping me. I have recently stopped breastfeeding so the last hope I had of blaming the babies is over and I am coming to final, depressing terms with my body. This is what I’ve got. It works. I can run and jump and swim and dance, and I so grateful for that. But when I do any of those things, I shake and jiggle and flop, and that’s a little harder to appreciate.

I went to get fitted for a bra recently, because my shape has changed in my post-breastfeeding life. The woman assigned to do my fitting told me, with a sour face, that my breast tissue was wide, wrapping around my rib cage more than most women’s. And I wanted to snap ‘yes, I know, they’re pancakes. Now get me a damn bra that fits anyway!’

She brought me a few options, including a hilariously awful old-lady bra in hot pink (so bad I sent a pic to my sister with the caption ‘fml.’) In the end, though, I bought a sports/yoga bra and ran out of the shop; a different woman at the checkout said ‘oh these are brilliant – though of course you can’t wear them during the day’

And I wanted to weep with frustration. Even worse, I have worn it exclusively since – I don’t have a *better* option.

I had thought in the past that I might like to get plastic surgery. Thirty-four is too young to be done feeling happy with your body, and all the cardio in the world isn’t going to change the fact that I breastfed three kids. When I think about it now, I tell myself that as a mother of daughters I need to set an example, but really I’m just too cheap and pain-averse to do it, not to mention too lazy. And my husband thinks I’m being ridiculous, which is…good, I guess? He says ‘You don’t have teenager breasts. You’re not a teenager!’

In the last few days, my son has taken to saying ‘silly old mummy!’ – a phrase he learned from Winnie the Pooh. When I told him I didn’t feel old, he said that I was objectively old and I should get used to it (I paraphrase). Maybe my discomfort with my body is an outgrowth of the fact that I may not be objectively old but I am objectively middle-aged and that, well, sucks. I don’t want to be a teenager, but I don’t love watching my body deteriorate either.

I spent a lot of time wishing that I could have carried my girls longer: every extra day, we clawed back the chance of infant mortality or cognitive impairment. Extra baby weight or diastasis recti was a small price to pay for a diminishing chance of major developmental delays. My medical team was thrilled that we got to 31 weeks, but I still wish I could have done better, even a year later, when everything seems to have turned out fine. It doesn’t keep me up at night anymore, but if I could trade my physical presentation for my daughter’s health, obviously there’d be no choice. Since that is a given, I feel guilty that I have spent so much time in the last few months being frustrated with something I can’t change and wouldn’t want to anyway. If given the opportunity, I’d want exactly the kids I have and I’d want to breastfeed them again, and if pancake breasts are the price, well. That’s that, isn’t it?

BUT SERIOUSLY I wish I could have it both ways. Surely that’s not too much to ask.

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Identical Vs Fraternal Twins

05 Friday Jan 2018

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The thing that struck me about having twins – particularly high-risk twins, since that comes with so many more scans and doctors appointments – is that the whole thing is very, well, mammalian. There are different types of twins, characterised by different placentas and amniotic sacs, and there is a surprising amount of confusion among the non-twin-bearing public about how they work.

So I’ve written a quick guide, and include the usual disclaimer about how I’m not a medical professional, just someone who is surprised by the degree to which people are confused about the biology of twins who’s done a lot of googling.

First, there are fraternal twins. Fraternal twins occur once in about every 80 pregnancies, although the number is going up as maternal age rises and fertility treatments increase the incidence of multiples. Vanishing twin syndrome, in which one pregnancy isn’t viable and just sort of…fizzles….only happens with fraternals.

In fraternal pregnancies, there are two separate placentas with two separate amniotic sacs. They are concurrent pregnancies, but there are no links between the babies in utero; they just happen to be two babies born on the same day. Fraternal twins can be girl-girl, boy-girl or boy-boy, and while many pairs of siblings may look alike, they are no more genetically similar than any other pairs of siblings. There is a genetic component, however: a woman’s likelihood of becoming pregnant with fraternal twins is passed down the maternal line (i.e. mother to daughter), because it relies on a woman’s likelihood of releasing two eggs in any given cycle (though, as mentioned above, there are a number of other relevant factors as well).

The natural world is full of fraternal twins. Every animal that has a litter is, in essence, having fraternal twins.

Identical twins occur once in about every 400 pregnancies, but are (I suspect) less prevalent in the general population because there are some common complications that make fewer identical-twin pregnancies viable. Within the umbrella of ‘identical twin’ there are three separate types of pregnancies:

  1. Dichorionic-dizygotic: two placentas, two amniotic sacs. On an ultrasound, this pregnancy will look exactly like a fraternal pregnancy; in fact, some people do not know until they have genetic testing whether they have identical or fraternal twins even after birth (not all identical twins look alike. Mine don’t!)
  2. Monochorionic,-dizygotic: one placenta, two amniotic sacs. The placenta is divided into two sections, serving each twin individually, but the line can only be distinguished post-partum. This is the most common type of twin pregnancy and occurs in roughly 92% of identical twin pregnancies (though I have also seen reputable websites that claim its more like 60%. Since not all di-di twins will be confirmed as identical there is probably some wiggle room here).
    There are also blood vessels connecting the twins across the sacs; despite the roughly hojillion ultrasounds we had, I was never 100% clear on how that works. In twin-to-twin transfusion syndrome (TTTS), one of the more common and serious complications, the babies’ blood vessels are connected, and one twin receives more blood than the other (donor) twin. Selective intrauterine growth restriction, which is what my girls had, is a similar condition in which one twin has a larger allotment of placenta than the other. Most identical twins are different sizes at birth; sIUGR is diagnosed when one of the fetuses is below a certain percentile (I believe its 10th percentile but I couldn’t confirm that with a quick Google so I’m just going to go with it)
    TTTS affects about 15% of identical twin pregnancies and sIUGR about 10%. If you’re really unlucky, you can have both simultaneously; one does not preclude the other, though the differences between the two disorders are only subtle. Both are not possible in pregnancies without a shared placenta, so do not affect fraternal or di-di pregnancies.
  3. Monochorionic-monozygotic: there is a single placenta and a single sac. This occurs in about 2% of twin pregnancies and is super high-risk. Best practice as of 2017 calls for women with mo-mo pregnancies to be put on bed rest at 25 weeks and deliver at 32. The reason is that there is a risk of the umbilical blood vessels getting tangled within the single sac, which can have really awful, tragic outcomes. Mo-mo pregnancies are also at an even higher risk for TTTS and sIUGR, although I’m not sure why.

The type of twin pregnancy is determined by when the egg splits: if it happens early, you get a di-di pregnancy; if it happens late, mo-mo. Everything in between is mono-di. What surprised me is the definition of ‘early’ vs ‘late’: any egg that splits more than 13 days after conception will result in conjoined twins. Eight-13 days = mono-mono and a split between five and eight days results in mono-di.

One note about identicals: in very rare cases, they can be different sexes if one of the babies has Turner Syndrome and the other does not. Turner Syndrome occurs in 1 in every 2,500 births, but its incidence in twins is extremely small – like, five documented cases ever. Still, I was floored to find out there is any instance in which identical twins can have different sexes.

You may think you don’t know enough identical twins for the 1/400 number to sound right; this is because (I think) there have been dramatic advances in maternal/fetal care for twins in the last decade or so, as well as major improvements in neonatology, which is a fast-moving field. In most cases, the treatment for complications is premature delivery, which on average has much better outcomes now than it did thirty years ago (which is not to say there aren’t lots of healthy humans who were born prematurely out in the world, though there is not great data about how they fare in old age).

When we told my parents we were having identical twins, they said ‘but how do you know?’ and the answer is, there was only one placenta, so it was definitely identical. There is no way to increase your chance of having identicals; it just happens sometimes.

 

 

 

Christmas frickin’ Magic

29 Friday Dec 2017

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The last two Christmases have not been fantastic.

Last year, I finished work on Friday, 23 December, and sat at the kitchen table ready for the holidays. I remember saying ‘I am so excited!’ about an hour before I went to the bathroom and saw blood in my underwear.

For most women, that’s called a menstrual cycle. But I was 23 weeks, 6 days pregnant. I had had an ultrasound earlier that day and it had been positive – it was a high-risk pregnancy but things were generally stable and I left feeling lighter than I had in the past. I was on the cusp of viability! This was HAPPENING!

I was at the hospital less than half an hour later.

The same doctor who had scanned me earlier that day came in, and confirmed that I’d had a bleed but that both girls were still moving. It looked like it might just be a one-off, and then it happened again. And again. And faster and faster.

I chugged water from paper cups in the triage area, running laps between the bathroom and our curtained-off area. A couple hours later, I was transferred to Labour & Delivery – not a positive sign – where I thankfully had a private room with ensuite bath (not all rooms do) and could schlep between the bed and the toilet. I noticed a tiny new stretch mark, running north from my bellybutton, and stared at the blue screensaver on the computer kiosk in a corner of the room, only realising the next morning that I could have turned off the monitor. But by midnight, the bleeding had just…trailed off. The same doctor – bless you, Catherine Aiken – came in to discuss delivery and steroid shots (I got one) and the NICU team came to prep me for the worst. Daphne was 400 grams at that point, and would not have been expected to survive; Fiona, at about 540, stood a fighting chance. Ian went home at about one in the morning and I spent the rest of the night the same way – staring numbly into space, trying to sleep, punctuated with trips to the toilet that confirmed I was mostly not bleeding anymore.

The next morning, a midwife’s assistant brought me tea and toast. I sat on the inclined bed with a Styrofoam cup of tea in my lap and sobbed and sobbed, while my daughters – now an even 24 weeks, and officially Viable as far as the medical establishment was concerned – wiggled and thumped inside me.

I was retrospectively diagnosed with a partial placenta previa, a complication that can be fatal to mum and baby – or can be so minor as to barely register as a complication at all. I left the hospital on Boxing Day, and we had family Christmas two days late. A week later, I had another bleed – a much more minor one – and spent New Year’s in the hospital. And that was last year’s holiday season. Yippee!

That would be enough to feel like I had to bring the Christmas Magic this year, but it turns out there is a theme. Two years ago, I had a miscarriage at 11 weeks pregnant (later diagnosed as having been caused by Graves’ Disease – basically an overactive thyroid), on the 17th of December. It had been an easy, breezy pregnancy to that point – things had gone 100% according to plan with minimal morning sickness, and once we crossed the 9 week mark I thought, ‘well this is fantastic; my chances of miscarriage now are like 2%’

Well, someone has to be in that 2%.

My memories of the miscarriage mostly involve crying: at the ultrasound, when they confirmed there was no heartbeat; in the shower, on the toilet, in my mother’s arms when I found the ‘big brother’ shirt I’d ordered to my parents’ house. Eventually I found a grief anthem: I would sing a chorus from a Ben Folds song and allow myself to feel All the Feels – sometimes I sang it twice – and then I’d pull myself together. All the same, it was a rough few weeks that stretched into months, when we learned that I had to wait until my thyroid was managed to try again.

This year – and every year from now on – I am free from reproductive stress. Our family is complete; this uterus has closed up shop. But as the 23rd of December approached, and I realised that last year would cast a longer shadow than I had anticipated, I felt a lot of self-inflicted pressure to make this holiday special. To start new traditions that would drown out the stress and disappointment of previous Decembers. To celebrate that we had come out of a difficult couple of years with three healthy children. Basically, to create Christmas memories that would drown out the crumminess of the last two years.

Here is the problem: my baby daughters don’t care; my husband doesn’t care (at least not nearly as much as I do); and my son just wants to eat treats and open presents, and will have only the haziest memories of this year if he has any at all. All five of us have colds, except for Theo, who is stuck at home because nursery is closed for the week and is going stir crazy. Holiday perfection has taken a backseat to sleeping and trying not to succumb to our desire to just plop our three year old in front of Paw Patrol and call it a damn day.

Where there has been magic, it has been incidental, which I guess is a good lesson to take from the festive season. Daphne waved at her grandparents and aunts during a Skype call on Christmas, a development that is way ahead of schedule and for which there were many witnesses. In the last four days, Fiona has become an indisputably mobile baby. She doesn’t go fast or far, but she doesn’t stay where you put her, either. Theo’s math skills have taken a step forward – when counting pound coins he received with a piggybank, he got to 8 and said ‘I think I have ten!’ And all three children started playing together for the first time when their new toy, Wobble Bear, was placed between the three of them, which felt like a freaking Christmas Miracle. Some of this stuff was facilitated by Christmas, but its mostly every day stuff that we noticed because we’re all sitting around driving each other a little nuts.

It will take more than one week of bad weather and sick children to erase the scary sadness of the last two Christmases, and an insistence on a CHRISTMAS FAMILY BRUNCH, DAMMIT are probably not going to help. But that’s a lesson in and of itself, and I will take it.

The Tiny Baby Blues

26 Tuesday Dec 2017

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I met a family last week who had an extremely premature baby. I had two extremely premature babies, but this baby was so premature that I was reduced to saying, essentially, ‘oh, shit, that’s an early baby.’

I have been thinking about that family a lot since. They arrived at the NICU – our NICU – a couple months after we left and stayed for a long time, though they are home now. But I keep feeling regret for them – not that they spent four months with a baby in the hospital, though that sure sucks a lot – but that they left the hospital without the resources that they would have had if things had gone more smoothly. Its hard to make friends with other parents when your experience diverged so sharply from everyone else’s so early, and its hard to settle into a rhythm as a new parent when you feel alienated from everyone else and their robust, healthy, oxygen-free newborns.

When I was pregnant with my first child, my husband and I did a birth-prep class. We had been warned that the content was not especially useful (it wasn’t), but that there was a lot of value in meeting your classmates – classes are organised by neighbourhood, and we live in an extremely fertile area, so our classmates lived around the corner, down the road, up the street – we were extremely geographically concentrated. When one of the babies was born early, the father sent an email to all of us saying how nice it was to meet everyone and he hoped to see us again soon sometime.

We had a good laugh about that at our fourth annual birth-prep group holiday in October. We saw each other almost every day all summer, and are still in regular contact with virtually everyone in the group, which has swelled (with second and, in our case, third children) to 32 people.

My group are outliers; most people don’t end up taking regular vacations with their parenting classmates. But most people do leave the hospital with a roughly shared experience of birth and new parenthood. Plus a baby. Most people leave the hospital and take their child with them.

For NICU families, it isn’t like that. I found it relatively easy to leave my daughters behind, not because I’m a callous witch, but because they were clearly…not finished. They were in incubators and they clearly needed to be. I found it harder at the end, when we were in sight of a finish line that never seemed to get any closer, and the girls looked and acted like babies instead of fetuses.

Still, from the moment they were born, I thought they were perfect. I wanted to tell people about my gorgeous twin daughters as much as any other new parent. When I was two weeks postpartum, I took my son to a birthday party and people asked how I was. It was only as I watched their eyes widen that I realised I had to adjust my rhetoric a little. ‘I just gave birth to tiny, perfect, extremely premature babies!’ isn’t exactly cocktail fodder. No one knew what to say. I skipped the next preschool party.

Of course there are families in the NICU who are going through something similar to what you’re experiencing. When people ask if I made friends in the NICU, I say ‘well – Facebook friends.’ I did meet people whose acquaintance I value, but none of them live within a twenty mile radius. Catchment areas for Category III (most intensive) NICUs can be huge; there are only a few in the UK. There are always families coming and going, and there is a hierarchy. One woman took weeks to warm up to me, presumably because her kid was having a rough go and she didn’t want to deal with another baby having an easier time than hers.

So I’ve been thinking a lot about this family I met recently, who had four crummy months in the hospital only to find themselves starting from a different place than everyone else who has a baby the same age (actual or adjusted) after they got discharged. I’ve wondered what could be done to make it easier for them, and I’ve wondered what I could do without coming across as an overzealous weirdo. I haven’t come up with much so far.

 

 

Fertility & Social Media

17 Sunday Sep 2017

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I look cute, but also, this pic makes me feel like kind of a jerk.

During my second pregnancy, I trawled Etsy for the perfect ‘Big Brother’ shirt and spent a while composing the pregnancy announcement in my mind. I had it ready to go. And then I lost the pregnancy.

When I started writing about my experiences as a parent, I fully expected to write about my miscarriage, which happened in December 2015. But it turns out I don’t have that much to say about it. It happened. It was awful. I do still occasionally think about what life would be like if we’d had that one baby, though I think about it less and less as I get to know the two I ended up with.

Anyway. The ‘big brother’ tee shirt never got its day, and I began a year of uncharitable crankiness about other peoples’ pregnancy announcements. Like many people my age, I’ve been on social media for over a decade, and have hundreds of contacts with whom I have minimal actual contact in real life. That woman I met at a wedding? Or the  conference? Or the person I hung out with for four days straight at Bonnaroo and then never again? Check, check, and check. And in the time between miscarrying and receiving the green light to try again, I think all of them got pregnant.

Announcements obviously run the gamut: some people post ‘btw internet, we had a baby’ while other people go full-on Beyonce. But when you want to be pregnant and haven’t had any luck, it is hard not to interpret all of them as preening: ‘#april2017! #soblessed!’

So when I got pregnant again, this time with twins, I put a lot of thought into how to tell the world. Because TWINS! Right? But on the other hand, I knew of a few friends who have had trouble conceiving. Perhaps more importantly, I knew there were even more people I didn’t know had trouble conceiving. I didn’t want to be THAT girl.

In my period of infertility, there were a few friends – not Facebook friends but real-life friends – who got pregnant. Hurray! I did not begrudge them their reproductive success. Even so, it meant the world to me (it still does, more than a year later) that they spoke to me or emailed me and said ‘this probably sucks for you to hear, and I’m sorry to cause you emotional turmoil, but I’m pregnant.’  It didn’t actually cause me much turmoil; it was easy to just be happy for them, and grateful to have such thoughtful people in my life.

And then – finallyyyyyy – it was my turn. A friend took a picture of me with my beloved Peugeot bicycle in her front garden. My pregnancy hair looked amazing. My bump (about 18 weeks at that point) looked sweet and compact. My thighs looked enormous, but can’t win’em all. And so almost without thinking, I posted it. #Frannyhavingtwins #goodhairday

And that is how, in a minute, I became the thoughtless jerk whose posts had made me glower for the better part of 2016.

Its hard to know what the right balance is. Its not like people should keep their children secret. The world is full of babies. That’s a good thing. Babies bring joy and light and hope into the world.  But I think maybe we should all agree, collectively, to put a moratorium on the following: #soblessed, #blessed (those two don’t need to be used by anyone, for any reason, ever again. Google it. I am hardly the only person who feels this way), #fitpregnancy, heart-on-uterus pics, and ultrasound images. I don’t need to see inside your body, Girl from Middle School.

I know how hard it is to resist. As soon as I got pregnant, I thought: tee shirts! Chalkboards! Balloons! Glitter! Tiny baby shoes! ALL THE PINTEREST! But thank goodness my laziness was stronger than my hormones, because I know how hard it is when you want to be pregnant but are not.

Now that I’m a Mum of Three

19 Monday Jun 2017

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Didn’t plan on having a litter.

 

When my first child was born, I remember walking dreamily around the hospital room telling a friend that I couldn’t believe something so perfect had come out of me. Objectively, this was not true – kid was a weird looking baby. He was super scrawny, and the first time my sister saw him, she squeaked ‘he looks like an alien!’

(she wasn’t wrong)

Maybe because of the persistent anxiety that defined this pregnancy, or because they were whisked away in incubators while I still felt too shaky from the c-section to touch them, or because two babies is a lot of baby – I didn’t have that this time. I have felt fierce, and protective, and grateful, and scared. But a couple days ago, I looked at my two daughters and said to them ‘I love you so much!’ and was surprised to realise that it was the first time the phrase had come naturally to me.

I learned I was having twins ten months ago, and today, I still struggle to believe that I have three kids – even with all three of them in front of me, it doesn’t seem real. I am still recalibrating my life as a parent – this isn’t the family I imagined, and the third kid is the hardest part. And to be clear, are all the third kid: Theo, when he runs into the bedroom at 6:30 on the nose to ask if he can watch Paw Patrol; Daphne, when she screams because she’s starving but the boob is RIGHT THERE; Fiona, when…well, she’s actually a pretty chilled out baby but she definitely has her moments. I want all three of these kids, but I didn’t want three kids, and I’m still mourning the vision I had for my family, even as I feel myself falling more and more in love with what I actually have.

 

Shit you shouldn’t ask NICU parents

03 Saturday Jun 2017

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Sniff you later, NICU!

My twin daughters Fiona and Daphne were born at 31 weeks this February and were teeny tiny perfect little peanuts. We’d known from early on in the pregnancy that the girls would be facing a long NICU stay, and I think the advance warning was 100% key to my (relatively) stable emotional and mental state throughout the ten weeks we spent on the NICU.

But prepping the people around me was hard. I kept telling my dad we expected the girls to be about three lbs (1.5 kilos) and he would make a choking noise on the phone which, frankly, was not helpful.

In one memorable conversation, I said ‘we don’t know when they will come home even after we have a c section date’

He said ‘oh yeah, because they’ll be in the NICU for a few days.’

‘No, Dad. We’re hoping for 4-6 weeks in the best case scenario.’

‘WHAT?!’

I mean, how would he know? He was just worried, as of course we were too. But managing other people’s expectations gets exhausting really damn fast, especially when you’re working so hard to manage your own. So here is a list of NICU do’s and don’ts for family and friends.

1. For the love of god, don’t ask when the baby/babies are coming home. Do not do this. DO NOT. I know it seems like a totally innocuous question but a. everyone asks and b. as with many long-term hospital stays, the kids are in there until they get discharged. Something can go wrong up until the moment you walk out the door, and I spent most of the ten weeks holding my breath. In Fiona’s case, she had a final, pre-discharge blood test – at which we discovered she was anaemic. She spent another week in the hospital while they monitored her haemoglobin levels.

The best analogy I have come up with, for those of you with friends in academia, is that it’s like asking a PhD student when they are going to graduate. The answer is ‘as soon as possible.’

2. Don’t expect photos. Even the relatively healthy babies are often hooked up to a lot of crap – oxygen, breathing, heart rate and apnea monitors are pretty standard. Really, really early babies are often a non-skin colour – blue or translucent – and breathing apparatus obscures their faces anyway.

3. Hopefully this goes without saying, but do your best not to express alarm at a baby’s weight or age at birth.  Daphne was under two lbs. I know that’s tiny. I dislike telling people because they look so startled. But of course, not all NICU babies are early; some have a rough start for other reason. A friend recently spent nearly three weeks in the NICU with a past-term baby, and the most alarming thing I witnessed in the NICU was a 37 weeker rushed in from labour & delivery (thankfully, that baby was home in under a week).

4. Do all the things you would normally do for parent of a newborn – bring food, send cards, keep in touch via text messages (I personally loved texting – you can’t speak on the phone in the NICU, but texting was allowed. When I was spending hours in a hermetically sealed room, with alarms beeping around me, I was beyond grateful for the friends who sent me chatty texts, especially when they kept texting over a period of hours or days). Basically cultivate the same ‘it takes a village’ approach that you would if the baby was at home. Virtual support is still support, and it’s something you can offer even if you are far away or pressed for time.

5. Don’t assume the mum is getting sleep because the baby isn’t home. You are strongly encouraged to pump breastmilk for NICU babes, and for first time mums especially, it can be stressful and time consuming. And it has to happen on a regular schedule – so even if the kid is in the hospital, there is a good chance the mum is getting up every four hours to milk herself.

6. Do send media recommendations. I found most books to be a little too much for me, and I didn’t like to bring books into the sterile environment anyway – when I read them, I read them on my phone (sterilised daily with a Clinell wipe)(my husband brought gross dusty paperbacks in all the time, though, so – personal preference). But I read longform journalism, listened to podcasts, and while I was expressing I watched Netflix shows that I’d cached on my phone.

7. Don’t send pics of your healthy baby, if you have one. A friend sent a pic of her healthy, smiling newborn with the caption ‘forgot how great these smiles are!’ And I wasn’t angry, exactly, but I had two kids hooked up to machines in incubators at the time and I had a hard time mustering enthusiasm for her sweet healthy baby. I’m not proud of myself – I wish I had been more generous of spirit – but I don’t think I’m alone among NICU parents. Stupid healthy babies and their stupid clueless parents.

One in ten babies are born early or unwell, so hopefully this advice will never be pertinent to you, but odds are it will. That said – to avoid ending on a dour note – most NICU babes are just fine. A rough start doesn’t necessarily dictate what happens when a baby goes home, but it sure does suck while it’s happening, and having the right kind of support can be a huge help.

So let me tell you about this horrific pregnancy I just had.

30 Tuesday May 2017

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It turns out I have a lot more to say about parenting in the abstract – having branded myself, officially, as a Mummy Blogger (ugh) I’m all of a sudden at a loss for words.

You guys, I am never at a loss for words.

So I decided to go for it. 


The girls at about three weeks old (34 weeks gestation)

I’m writing this because even three months removed from the actual pregnancy, it looms over me, as I imagine it does for other women (and men, and people) who have dealt with a scary or high-risk pregnancy. I would have loved to read my story six months ago and I would love for it to be a source of strength for families at a different stage of their own experience.

Lucky you, though, I decided to save miscarriage and the NICU for another day.

In February I gave birth to two extremely tiny identical twin girls, Fiona (at 1.3 kilos or 2.9 lbs) and Daphne, who weighed in at 820 g (1.8 lbs). They were 31 weeks gestation and had suffered from selective intrauterine growth restriction, or sIUGR. Both were small for 31 weeks, but Daphne was barely on the charts – she was somewhere near the 0.1 percentile, whereas Fiona was somewhere around the 9th or 10th percentile. That is also small enough to be considered growth-restricted, and the NICU consultants told me she was probably also somewhat compromised in utero.

We were diagnosed with sIUGR at about 16 weeks and had weekly ultrasounds to monitor growth and, more importantly, blood flow in the umbilical arteries. The gist of sIUGR is that one baby has a larger share of the placenta than the other, but it is also common for the smaller baby to have a narrower umbilical artery and/or a bad connection between the artery and the placenta. In Daphne’s case, she had a cocktail. She had All The Things. It wasn’t a great situation. Once diagnosed, we had a target C section date of 32 weeks, though I held out hope that we could make it to 34 if we were lucky.

Every week, we would watch the blood flow in the umbilical artery to make sure, essentially, that blood wasn’t backwashing into the artery between heartbeats. When that happens, intervention often follows fairly swiftly.

Things were going pretty well, actually, until the 23rd of December, when I had a bleed. I was 23+6. As my legs shook and the midwife put in an IV, the doctor stood above my bed and said ‘I don’t think we will deliver these babies tonight, but that is just a feeling.’

They never figured out what it was, but after about three hours the bleeding just….slowed, and eventually stopped. I spent the night in Labour & Delivery drinking water, staring at the blue computer monitor, and schlepping back and forth to the toilet. When a nurse in green scrubs brought me tea and toast the following morning, I sat with the tray in front of me and sobbed.

The following week, there was backwash in the umbilical artery and it was time to consider laser ablation surgery. The procedure was effectively a selective reduction. While in rare cases, the smaller twin thrives after connections to the bigger twin are severed, in most cases, the little one doesn’t make it; instead, the larger one gets more time in utero and a substantially mitigated chance of profound disability. Our little one – already named Daphne – was so little that we had to assess her chances of survival at about three weeks behind her gestational date. So when she was 28 weeks, we looked at statistics for 25 weekers.

At 25+4, we went to London to meet with a specialist. The procedure is not performed past 26 weeks so it was absolutely our last chance. We knew the moment might come but it was an agonizing weekend. There was a very real possibility that, without intervention, neither girl would make it. But there was an equally real possibility that both girls would be just fine. There was no right answer, but we went to London having decided that the procedure was the best thing for our family. I was so sure we were going to do it that I had already contacted grief counseling services at our local hospital.

And then, magically, everything looked fine.

My husband had by this point taken to carrying around a thick stack of scholarly articles covered in pink highlighter, and I had taken a case-study approach – I had scoured the internet for similar stories. So it was both alarming and gratifying to see a team of six medical professionals from around the world clustered around the ultrasound machine, all trying to figure out what the fuck was happening in my uterus. Spoiler alert: they decided that 32 weeks was still a reasonable goal, and that 33 was not unimaginable, and sent us on our way. We got Japanese food and almost missed our train.

I’ve tried to be succinct here, so I will skip the part about how I had another bleed, spent another weekend in hospital, got put on monitoring, and then ultimately delivered due to complications entirely unrelated to sIUGR (high blood pressure and reduced foetal movement).

We delivered at 31 weeks via emergency c section, and our girls spent 9 and 10 weeks in the NICU respectively. Despite the fact that that is a helluva long time, they had relatively straightforward experiences, or at least it could have been much worse.

Today the girls are 15 weeks old, or 6 weeks and 2 days, adjusted. Both have begun to smile but prefer to look quizzical, gifting me infrequent but radiant open-mouthed grins. They have largely held their growth curves but I am optimistic that they will nudge up a few percentiles in the next few months. In short: it all sucked but we appear to be coming out the other side. At this point, my day-to-day experience of these babies is like any other woman with six week twins, and the most amazing thing is how quickly the NICU has faded behind us.

If you are a stranger on the internet in the throes of a scary pregnancy, and I can be of use, please let me know.